Politicising Medical Education

The plan to set up two new medical colleges, at Baramulla and Anantnag, is fraught with danger.

Building two new medical colleges, which will require crores of rupees in land acquisition, construction and development of infrastructure, and also the appointment of required staff, is not a good idea. The State of J&K can ill-afford such big-ticket expenditures, which have little future in an expected time of fiscal belt-tightening and austerity. No doubt, it will generate employment for a few thousand lucky souls, but will it serve the purpose of educating our modern doctors in modern medical methods? Highly unlikely. The announcement of two new medical colleges is aimed to please the easily gullible middle and lower classes of Kashmir, and beckon them in a highly populist and suspect way, which apparently did not serve the purpose, if the turnout of the recent Lok Sabha elections is anything to go by.

Opposition to the new medical colleges stems from the fact that recent medical education trends have shown a process of continuous consolidation, as opposed to expansion. The first few years of medical study are spent in the lab and class-rooms, and not hospital wards. Labs and class-rooms can be constructed anywhere, hospitals need proper planning. So rather than ‘re-invent the wheel’ with new medical colleges, it would be more to the point to upgrade and increase infrastructure at already the existing facilities. In this case, it could be achieved by increasing the intake in the fully-functional Government Medical College and SKIMS Medical College at Srinagar. The GMC, Srinagar, has a distinguished history, and has produced some great doctors and medical teachers, and has been the backbone of medical education and service in Kashmir for over five decades. The SKIMS Medical College, initially a private venture, has now become a government institution, and has a tie-up with the SKIMS for teaching. Both colleges have large swathes of land available for expansion, a large number of posts vacant for employment, a large cadre of alumni to fall back on, and can be the backbone of the next phase of health-care expansion in Kashmir.

A point made in favour of a rural medical college is this: that district hospitals and in-service health professionals in rural areas are under-performing, and that by setting up a medical college, the facilities will automatically receive an upgrade. This is only partly correct. If there is a proper tie-up with the existing medical colleges, and the limited resources that our state has are properly used, then it is possible that district hospitals become peripheral teaching hospitals for under-graduate and post-graduate training. Just as the GMC in Srinagar has over 14 allied hospitals, it would not hurt to add one more, that of the District Hospital at Anantnag. And for a relatively light hospital like the SKIMS Medical College (formerly the JVC), it would increase intake and better the services if the District Hospital at Baramulla has a tie-up for teaching. The possibilities are endless.

Imagine a situation where a patient will require referral. Rather than the chaotic referral process at present, we will have the two colleagues referring and discussing patients, since they work in tandem, not independently. Since the hospitals will be inter-linked for teaching, and patient management, it will only improve patient care. As also, there can be free exchange of knowledge and ideas, with clinical teachers from the Srinagar colleges travelling to the periphery to teach and spend time, for a fixed period.

An argument against travelling will be made, as students have to undergo didactic lectures as well as clinical teaching. In major medical colleges of India, the final year, or the 8th and 9th Semesters, is now free of didactic lectures, and students are posted in wards for the whole year. They work with various units in the manner of interns. This model can be used for our existing colleges after the intake increases, thus meeting the shortfall of peripheral doctors. Interns can similarly be posted out, and so can the post-graduates.

There will be a need to appoint clinical teachers, no doubt, in the District Hospitals, and also upgrade the knowledge and practises of the doctors already working there. At the same time, due credit must be given to the doctors of the Directorate of Health Services in Kashmir, who are working in these areas, without the pomp and glory of the medical colleges. For them to be a part of a medical college hospital will be a matter of great pride.

It is in the best interest of everyone concerned, therefore, that rather than construct and equip two new medical colleges, and spend money that will find its way to the coffers of illegal contractors, it would be better to upgrade existing facilities at the GMC in Srinagar and the SKIMS Medical College, and designate the District Hospitals of Anantnag and Baramulla as Teaching Hospitals for undergraduate, interns, and post-graduate students. The shortfall in the planned increased intake of the State MBBS seats would easily be offset by an increase in intake in the existing medical colleges. One sensible look into this matter, and we will see another example of Kashmiris being fooled.